Feasibility of using virtual counselors to collect family health histories from underserved populations

Family health history is an important predictor of disease risk yet is underutilized in clinical practice. Although computerized tools are currently available to help patients collect family history, they are often too complex for underserved patient populations who might lack the literacy or computer experience necessary to use effectively. To address these barriers, we developed a virtual counselor (beta prototype) to collect and record information from patients about their family health history for a select set of common, chronic conditions. Participants ‘answer' the counselor's questions by choosing among touch screen button responses. Interviews were conducted with 20 participants recruited from a patient research registry. Approximately, 85% were female, 65% had a high school degree or less, 50% were African American, and 65% had household income < 25K. Participants rated the virtual counselor as easy to use (90%), understood the questions being asked (95%), liked the tool (80%), rated tool quality as very good or excellent (69%), and were highly satisfied with the tool (75%). Compared to family histories obtained by a genetic counselor, the virtual counselor identified 73% of first and second degree relatives and 54% of the health conditions assessed within the tool. This study demonstrates the acceptability and feasibility of using virtual counselors to collect family health history in an electronic format, and overcomes previously identified barriers among underserved populations. Future efforts will focus on refining the virtual counselor to improve collection of more complex family trees (e.g., half siblings, twins, nieces/nephews) and accommodate additional diseases and languages.